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. 2020 May 6;9(2):e000910. doi: 10.1136/bmjoq-2019-000910

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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Cycle time for the second phase of the project, maintenance and further improvement (September 2017–April 2019). Processes within the overall cycle time are shown. Total cycle time fell from a mean of 66.75 min in the first 4 months to be maintained at 60 min in the final 4 months to April 2019. Time spent with provider, nurse and physician fell from a mean of 53.5 (first 4 months) to 48 min. Despite a small reduction in time spent with the provider, patient satisfaction scores remained high and more patients were seen in the clinics.